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One of the commonest discussion threads on the Forum has been about gene expression profiling and I’m carrying forward my response to the latest exchange between patients and carers here in case it is helpful to others.
To focus targeted treatment it is not the primary anatomical site itself that is important but the molecular profile of the disease (cancers, even in an identified primary site, are likely to be different). A molecular ‘snapshot’ of a tumour from a biopsy is a helpful addition to standard immunohistochemistry to target treatment and the evidence is growing that it has a high degree of accuracy. Of course, the cancer may mutate/change over time and almost certainly does and this is the same risk faced by all cancer patients undergoing treatment. Multiple biopsies are a big ask of a patient (until this can be done with liquid biopsies that identify the circulating tumour cells) to keep track of the disease over time.
There is a helpful and easy to read article here written by the US-based CUP expert Tony Greco which was published last week that is interesting. https://www.cupfoundjo.org/wp-content/up … ov2016.pdf At the foot of this page is a list of the main companies, that we know about, undertaking gene expression profiling https://www.cupfoundjo.org/diagnosis/tests.
Clive from Southampton responded wisely in relation to his patient experiences: ‘Doctors deal with statistics and they say only 16% survive the first year of CUP. Maybe if they did this test more would survive as the chemo would be less of a guess. Most important is to remain positive and don’t believe the doctors predictions.’